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deleted862527
Thoughts on this? Personally, I find it unhealthy. Humans aren't made to continuously work for 20+ hours and still be sane and healthy. However, I am not a practicing Physician.
What are your guys thoughts on this?
Thoughts on this? Personally, I find it unhealthy. Humans aren't made to continuously work for 20+ hours and still be sane and healthy. However, I am not a practicing Physician.
What are your guys thoughts on this?
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sucks ass
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deleted862527
Nice cockiness. Not like I just joined yesterday on SDN.
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Dayum. SouthernSurgeon. Did you happen to bring some aloe for that burn?!?! The OP could've had a family!
I'll take the bait and reply. 28 hours isn't nearly as bad as 32-36 hours. It's doable and sometimes necessary depending on the program that you're in. SouthernSurgeon has definitely worked 100+ hours a week, just like I have and many other surgical residents around the country. It is what it is. You just accept that there's work to be done and you don't go home until it is. If this is unpalatable to you then PM&R is always a good gig.
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grapefruit17
I wouldn't mind it if I get a day off the next day. The hard part so far weeks where I work every day and don't get a day off. Those suck because there's stuff at home I have to get done and I'm usually too tired to do it. Havjng one day off a week is nice just to pay bills and do dumb stuff like that while cooling down
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deleted862527
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As has been stated, there are several marathon threads out there. Bring popcorn, but please don't comment on them.
As a summary, some medical students think these shifts are inhumane and are appropriate to compare to slave labor/torture.
Many residents think they are practical, allow for greater schedule flexibility, and think the students are being somewhat histrionic.
There are several studies (Icompare among them) which indicate mortality and error rates are equivalent between 28 he shifts and shorter shifts. This is possibly related to handoffs in care. I would posit that this might be true, but it also has to do with the fact that the same limited resources are being invested in different ways. It probably takes more money and more personelle to create a safer environment, not more handoffs and shorter shifts. It's a complicated question which I admit I'm not that familiar with.
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Originally I hated it. I think so much in medical education and training is borderline inhumane. However, I have worked 24 (28) hour shifts. Yeah they're rough. But having a post-call day is great. Versus having to work a 16 hr day and go home and come back the next day. At least you get a day off to recover following a 24.
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This. Not a resident yet, but I've had a rotation where I worked 70 hours in 5 days (no days off) and it was awful. I'd rather have take a 28 hour shift in there and had a day to rest up than pull 5 straight 12+ hour days with some of them being 16-18 hours. Maybe I'll change my mind in residency, but I enjoy having a full day to myself every now and again, so I doubt it.
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grapefruit17
Fwiw I've worked 13 to 14 hours every day this week but thankfully have the weekend off. I will be working 12 to 14 hour days for 12 days straight after that. Brutal.
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I wish I did 28 hours shifts during intern year.
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- nice, thanks for taking initiative and saying what many of us have been thinking
- you're supposed to say thank you for the abuse
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i'm gonna make my children stay up 24+4 hours watching sesame street to get 'em ready for the real world
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Incoming ms1 here, do you actually work 24 hours straight or are you in the call room for a third of the time? Thanks
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deleted862527
No problem.
Some of the people on this site have such egos it's ridiculous.
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You'll find that most feathers are ruffled when you challenge someone's fiercely held, albeit ill conceived, pre-conceptions about a given subject which virtually always leads to accusations that you must be a troll.
The more you think outside of the box, the more of a troll you have to be. There simply is no other way.
Welcome.
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deleted862527
The problem is them though, not us.
If they seriously take issue with an appropriate thread's topic, then it says more about them then us. Just shows you the significant amount of time they must spend daily on SDN Network, when they could be doing something more important then continuously roaming a website.
It's sad.
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deleted862527
The people taking issue with this thread instead of participating in the discussion could be doing more important things with their M.D. degree then roaming an SDN website, bashing a user they don't even know and accusing them of actions that aren't even true.
For those claiming 28-hour shifts are normal, why don't you take an extra 30+ hour shift if it's no big deal?
@SouthernSurgeon I heard works more than 100+ hours per week. Seems like he roams 100+ hours/week on SDN Network then actually practicing medicine if he is that sensitive of what threads are posted on SDN.
For those claiming 28-hour shifts are normal, why don't you take an extra 30+ hour shift if it's no big deal?
@SouthernSurgeon I heard works more than 100+ hours per week. Seems like he roams 100+ hours/week on SDN Network then actually practicing medicine if he is that sensitive of what threads are posted on SDN.
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This is an n=1 example from a former IM resident (now hem/onc fellow); During my ICU time as a PGY2 we would come in at 7am, pre round, round, get work done and before you knew it was around 10-11pm. That was usually the first opportunity for a nap and then invariably there'd be admissions or sick patients thereafter always interrupting any time you tried to get some rest. I would say I averaged 4 hours of sleep in a 28 hour call. Sometimes more like 5-6 others closer to 3.
Recall what your grade school teachers told you about two wrongs not making a right. Pretty childish to continue the bickering.
Also, the issue with your first statement is the idea that people continually ask doctors to do more, to put in more hours, etc. Realize that they're people too and that the choice of pursuing medicine is a service in it self. Whether it be roaming SDN, or something else, everyone needs their past time activities, especially to prevent being burnt out.
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deleted862527
Yes, I realize this. That's why I created this thread.
Well, it was childish for several users to take issue with a thread when they could have simply just ignored it--don't you think?
28-hour shifts aren't out of the norm. You suggesting another 30+ shift since they're roaming SDN on their down time contributes to the aforementioned problem.
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Literally 1 person commented about the redundancy of this thread. And he's right, this discussion has been repeated time and time again in this forum and others.
Good God, no wonder you're complaining about this. Your victim complex is staggering.
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deleted862527
No, I suggested it because users claim it isn't a big deal. If it's not a big deal as they claim, then what's the issue?
You're preaching to the wrong choir. Why not give some of your ethical advice to SouthernSurgeon or others on this thread? I did nothing on this thread but try to start a discussion. I recently just joined SDN, and all I did was create a thread. I checked a few pages before posting it, and I saw nothing of this topic listed.
I'm not playing victim, genius. People automatically jumped to conclusions claiming my intentions were to troll the SDN board.
Why don't you actually READ the post before making an illogical, stupid comment.
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My program does 28 hr shifts with only 2 hr sleep (guaranteed lol) while on IM ......
Personally, I did not have a problem with working the shift. However, I know several that did. They would get "scary" in terms of their thinking. Definitely not as clear as usual. I think it really depends on the person.
My biggest problem with residency is how you are treated like they own you and you really have no recourse. I have had "real" jobs and worked in HR. The stuff I have been told would never be allowed or at least that person would be called into HR. The work of residency does not bother me. The BS of it does .
Personally, I did not have a problem with working the shift. However, I know several that did. They would get "scary" in terms of their thinking. Definitely not as clear as usual. I think it really depends on the person.
My biggest problem with residency is how you are treated like they own you and you really have no recourse. I have had "real" jobs and worked in HR. The stuff I have been told would never be allowed or at least that person would be called into HR. The work of residency does not bother me. The BS of it does .
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It's not about you, it's about the patients.
I have epilepsy- I would literally possibly die on 2 hours of sleep after a 28 hour shift. Hoping I match psych and survive intern year.My program does 28 hr shifts with only 2 hr sleep (guaranteed lol) while on IM ......
Personally, I did not have a problem with working the shift. However, I know several that did. They would get "scary" in terms of their thinking. Definitely not as clear as usual. I think it really depends on the person.
My biggest problem with residency is how you are treated like they own you and you really have no recourse. I have had "real" jobs and worked in HR. The stuff I have been told would never be allowed or at least that person would be called into HR. The work of residency does not bother me. The BS of it does .
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Mind you I got 2 hrs once....
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What ungodly place are you doing residency? It's legit against ACGME rules...
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You will probably find many places violate the "rules". So far, I have not while on Psych
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On my 24 hour shifts, or even most of my night shifts, there was usually some sort of down time during the shift, and at least a few hours to take a nap. Sometimes, things were crazy and you were up most of the night, but there's usually a lull in admissions between midnight and 5 am when the ED starts to clear out, and patients are sleeping and behaving on the floor.
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I've probably worked a couple hundred 24 hour shifts - such is the life of a PICU fellow. Nights vary, sometimes you're running around and don't sit down once. Others you're not particularly busy but the timing of new admissions doesn't allow for any down time. Other times, the first or second half of the night is quiet only to have the other half be crazy. And sometimes, literally nothing happens.
From having LOTS of experience, it was the nights where there was downtime and my brain had a chance to 'switch off' for a stretch that were most problematic for me. Truthfully the busiest nights were the least worrisome in terms of my own judgement while I was the one responsible. In fellowship, we'd sign out but still have to stay while the teams were rounding to put out fires and take calls from the ED/Transport/Rapid Response, and those crazy busy nights were the ones where that last 4 hours would be rough. It was almost like parts of my brain would just go offline during that time like it knew "you have backup".
The other important part that could make for an easy or rough night was what had I done the night before...Was I on call Sunday but still had tried to have a social life Friday and Saturday? That would be a setup for a rough go.
Keep in mind, that through experience, what I would consider a rough night, vs some intern having a rough night, probably are two very different things. With sicker patients and more to balance, I still was undoubtedly safer than someone with little or no experience. That was one of the biggest issues I had with the old rules that singled out interns - you then placed 2nd years who had no experience with decision making while tired in a position of leadership and supervision while they were struggling to adapt to new physical demands. Just didn't seem the smartest.
Lastly, undoubtedly in my clinical practice, more things have been missed with frequent handoffs than because of being tired. ICU patients are complex and it's easy to get distracted during signout. And there were plenty of times where people would start off signout super thorough only to rush through the last few patients because they were tired, something happened, or even just that food got delivered.
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grapefruit17
Even in psych, you are a workhorse. A good portion of programs acknowledge that while you are there to learn, you will be doing a lot of extra work that needs to be done. 1st and 2nd year of psych at a lot of programs is tough. I work many hours a week. I still like my program so far. my current attending is a great guy/understanding so it makes my job easier that he doesn't hassle me.
One of my biggest annoyances is when I get a call saying "ok I need a note for patient x by 3:30 for insurance purposes". you look at your watch and its 3:00 and you have a meeting at 3:10. G_G.
still, even tho I'm pretty tired I won't complain. I love my field, and the people I work with so far are nice. these two factors make it doable.
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I think its pretty stupid that hospitals hire people for 24 hours and residents have to work 28 hour shifts. Ask any hospital administrator, if your mother was in the ICU, would you want the medical staff to be well rested or extremely fatigued while they perform procedure, plan her medical treatment, intubate, do codes, etc.?
Maybe in the call room writing notes.
True downtime might be a 4hr max and as little as zero in 28hours.
Not even patients want that.
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I don't want to seem like a whiny little child, but having little sleep in a period of 28 hour has so many detrimental effects on our health and it is ridiculous this is even aloud. I know we all have to "suck it up", but I seriously think we should have a "16-18" limit in a shift.
Absolutely absolutely agree. There is research linking sleep deprivation and all sorts of disease processes. Hilarious this is never included in the discussion. Why? Because some lives dont matter.
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I've done it both ways with the 16 hr work limit and only one day off per week. I'm more rested with having a 28 hr shift and a post call day and a day off in the week. Both ways aren't super healthy but with the 16 hrs you are rarely home with your family and the days off don't usually correspond to theirs. Having the post call day makes it more likely to be able to see them a bit. I usually go home eat breakfast and visit with them. Sleep and then wake up and they are home and we can have afternoon or evening together depending on how much sleep I got the night before, if any.
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Relatively new Pulm/ICU attending here
I did 28 hour shifts in residency and fellowship
Yes I hated them. It made me moody and bitter. Lost weight. Gained weight. Some of my hair turned white. Some of it fell off. I was glad to finish that phase.
But, I am the physician I am today because of the invaluable lessons I learnt at 3am in the morning. I have saved lives because of them. My colleagues from cush residencies and simply do not have those intuitive reflexes or skills that graduates from my program (and other busy programs) have.
This may sound cliched but it is true. You have to put in the time sacrifice and effort to be able to learn how to save lives. More so for surgeons. Think about the hours of practice needed to be a concert pianist, or the hours of training to be an Olympic swimmer.
If you want a a good lifestyle for yourself choose something else.
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I did 28 hour shifts in residency and fellowship
Yes I hated them. It made me moody and bitter. Lost weight. Gained weight. Some of my hair turned white. Some of it fell off. I was glad to finish that phase.
But, I am the physician I am today because of the invaluable lessons I learnt at 3am in the morning. I have saved lives because of them. My colleagues from cush residencies and simply do not have those intuitive reflexes or skills that graduates from my program (and other busy programs) have.
This may sound cliched but it is true. You have to put in the time sacrifice and effort to be able to learn how to save lives. More so for surgeons. Think about the hours of practice needed to be a concert pianist, or the hours of training to be an Olympic swimmer.
If you want a a good lifestyle for yourself choose something else.
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Might you tell us how you know this to be true?
Have you tested yourself vs your peers? Other than maybe a perception that having pushed yourself that hard must mean you got something extra out of training, what else can we base this conclusion off of?
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Our MICU director (who is/was very well respected) is one of the reasons my residency program (now a fellow) is in the beginning stages of abolishing 24hr calls in the units. It is far from from fact that having 24 hour calls as a resident makes you better. I did about 20 or so myself and do not see the benefit. Not saying that one is clearly better but just believe that there is way to much "i know that having 24 hour calls is better because I know" without any concrete evidence. We await the icompare trial results but the surgical training programs study is irrelevant to me given we're talking about non surgical training programs. I do agree that for surgical residencies being lenient with your shifts may be beneficial to those trainees to get more experience in the OR
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I don't have a randomized controlled trial to prove my assertion. It's my opinion. You can evaluate it, and decide for yourself.
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Depends on the night. For example, my last 24 was a few days ago. I started my day at 7am, spared about 10 minutes for lunch and 20 minutes for dinner. Was swamped all day with no breaks (except those short times to eat). By 230am that night/morning, I finally went to the call room. I was awoken to pages at 330am and 430am. Then had to get up for a code around 530am and stayed up after that to give report at changeover at 7am. So I got maybe 2-3 hours of sleep-- which was still a lot of tossing and turning and looking at the clock and checking my pager.
Yes there are days/nights that are a lot slower and you may get a good chunk of downtime to watch tv and sleep. But it's certainly not guaranteed. You never know how busy or slow a shift is going to be.
Side note-I'm currently 39 weeks pregnant. So yeah, the lack of sleep sucks. But the post call day is wonderful.
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While it sucks big time, if you have a postcall day it's nice.
I'll be honest, I disagree with the pretentious doc who said "At that hour, you don't feel bad cause you realize the patient is the sick one". Usually I'm thinking "I don't give a flying ****, I'm tired and want this **** to be over with!". Plus, when I'm at hour 18+, I'm cranky and non-empathetic. 😛
I'll be honest, I disagree with the pretentious doc who said "At that hour, you don't feel bad cause you realize the patient is the sick one". Usually I'm thinking "I don't give a flying ****, I'm tired and want this **** to be over with!". Plus, when I'm at hour 18+, I'm cranky and non-empathetic. 😛
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Longest I worked was 31 hours straight in residency, no sleep. I got lost driving home and forgot how my keys worked to my apartment.
I once also did 24 on, 24 off, 24 on, 24 off, 24 on as an attending and started talking to myself in my little doctor room like Gollum.
I don't think you learn anything from doing this crap other than you should never do it again. It is what it is though.
I once also did 24 on, 24 off, 24 on, 24 off, 24 on as an attending and started talking to myself in my little doctor room like Gollum.
I don't think you learn anything from doing this crap other than you should never do it again. It is what it is though.
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I've heard this a lot, but do you have an example? Is it more of a, "We don't care that you haven't slept in 24 hours, do it," and "I'm your superior bow down" or what?My program does 28 hr shifts with only 2 hr sleep (guaranteed lol) while on IM ......
Personally, I did not have a problem with working the shift. However, I know several that did. They would get "scary" in terms of their thinking. Definitely not as clear as usual. I think it really depends on the person.
My biggest problem with residency is how you are treated like they own you and you really have no recourse. I have had "real" jobs and worked in HR. The stuff I have been told would never be allowed or at least that person would be called into HR. The work of residency does not bother me. The BS of it does .
Not questioning your experience at all, just curious as to what exactly you're talking about.
Naw. The program would always position itself as open and available to address resident fatigue. But if you just follow some of the older cronies and their position on this topic, you get a better sense of what reality is.
Lets be honest, nobody teaches you that not sleeping for 28 hours is healthy. You wouldn't sell that to your patient and it definitely doesnt inspire confidence if you shared that right before doing a procedure on them.
And no, Olympic athletes actually have real physicians that ensure they get adequate rest as part of their training. If you know of an olympic athlete who goes 28 hours without sleep every 3 days please let us know.
Lets be honest, nobody teaches you that not sleeping for 28 hours is healthy. You wouldn't sell that to your patient and it definitely doesnt inspire confidence if you shared that right before doing a procedure on them.
And no, Olympic athletes actually have real physicians that ensure they get adequate rest as part of their training. If you know of an olympic athlete who goes 28 hours without sleep every 3 days please let us know.
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I don't like overnight calls and coming from a residency where we only did a few total over three years I was concerned starting my ICU fellowship that I wouldn't be able to handle doing them more often (180 in three years to graduate!). Like others in the thread I now strongly prefer overnight call to my residency schedule where we worked 14-16 hours a day six days a week in the icu.
I think what some of you are missing is the alternative. If you are going to work 70-80 hours in a week and still shower and eat and grocery shop during your off time you will also be sleep deprived in the no overnight call model. When they put the work hour restrictions in place there were studies and interns weren't getting more sleep and weren't feeling more rested. The possibility isn't that a patient has a doctor who has been awake for 18 hours versus one that just woke up and each know them equally well. The patient can either have a doctor who knows them well and has lived through the last day with them watching medication changes and mental status changes who hasn't slept in 18-28 hours. Or, the doctor could be a night float doctor who is equally overall sleep deprived but recently slept all day and then got thirty seconds of sign out about the patient's main issues and is covering 2-3 (or way more) times as many patients. Part of the reason the surgical program studies were done was because residents were requesting to go back to the old schedule. I'm sure there are people who prefer each schedule but I know more people who prefer overnight call rather than continuous long days if they are working 80 hours a week over a long time.
I think some of you are making better arguments about the eighty hour work week rather than the specifics of how it is broken up into shifts.
@J ROD How did your program guarantee two hours of sleep? Are they continuous? I know it might not sound like much but just getting a little bit makes such a difference for me.
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I think what some of you are missing is the alternative. If you are going to work 70-80 hours in a week and still shower and eat and grocery shop during your off time you will also be sleep deprived in the no overnight call model. When they put the work hour restrictions in place there were studies and interns weren't getting more sleep and weren't feeling more rested. The possibility isn't that a patient has a doctor who has been awake for 18 hours versus one that just woke up and each know them equally well. The patient can either have a doctor who knows them well and has lived through the last day with them watching medication changes and mental status changes who hasn't slept in 18-28 hours. Or, the doctor could be a night float doctor who is equally overall sleep deprived but recently slept all day and then got thirty seconds of sign out about the patient's main issues and is covering 2-3 (or way more) times as many patients. Part of the reason the surgical program studies were done was because residents were requesting to go back to the old schedule. I'm sure there are people who prefer each schedule but I know more people who prefer overnight call rather than continuous long days if they are working 80 hours a week over a long time.
I think some of you are making better arguments about the eighty hour work week rather than the specifics of how it is broken up into shifts.
@J ROD How did your program guarantee two hours of sleep? Are they continuous? I know it might not sound like much but just getting a little bit makes such a difference for me.
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